Provider Demographics
NPI:1548505035
Name:FUSIAK, TIMOTHY STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STEPHEN
Last Name:FUSIAK
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Gender:M
Credentials:DO
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Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:STE 8630B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6115
Mailing Address - Fax:757-275-9998
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:STE 8630B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6115
Practice Address - Fax:757-275-9998
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2019-06-15
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Provider Licenses
StateLicense IDTaxonomies
VA0102204499207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease